Plerixafor

Plerixafor Brand Name– Mozobil

What is Plerixafor

Plerixafor is a novel therapeutic agent used for the mobilization of hematopoietic stem cells (HSC) for subsequent autologous transplantation.

It is an inhibitor of the CXCR4 chemokine receptor and blocks binding of its cognate ligand, stromal-cell-derived factor-1-alpha (SDF-1a). CXCR4 and SDF-1a play a role in the trafficking and homing of HSCs to the marrow compartment. Originally, plerixafor was investigated clinically for the treatment of patients with human immunodeficiency virus.

During this investigation, profound leukocytosis was noted, which was determined to contain a significant number of CD34+ cells.

Clinical research of plerixafor shifted towards the mobilization of HSCs in patients with cancer. In two clinical trials, 298 patients with non-Hodgkin’s lymphoma (NHL) and 302 patients with multiple myeloma (MM) were randomized to receive plerixafor or placebo in conjunction with filgrastim for the mobilization of HSCs prior to autologous transplantation. In each study, significantly more patients collected >= 5 x 10⁶ CD34+ cells/kg from the peripheral blood with plerixafor and filgrastim than with placebo and filgrastim.

In December 2008, the FDA granted approval to plerixafor to mobilize HSCs to the peripheral blood for collection and subsequent autologous transplantation in patients with NHL and MM; plerixafor should be used in combination with granulocyte-colony stimulating factor.

Indications

• peripheral blood stem cell (PBSC) mobilization

For peripheral blood stem cell (PBSC) mobilization for collection and subsequent autologous transplantation in patients with non-Hodgkin lymphoma and multiple myeloma, in combination with a granulocyte colony stimulating factor (G-CSF)

NOTE: The FDA has designated plerixafor as an orphan drug to improve the yield of progenitor cells in the apheresis product for subsequent stem cell transplantation following myelosuppressive or myeloablative chemotherapy

Side Effects

1. abdominal pain
2. anaphylactic shock
3. anaphylactoid reactions
4. arthralgia
5. bleeding
6. constipation
7. diarrhea
8. dizziness
9. dyspepsia
10. dyspnea
11. erythema
12. fatigue
13. flatulence
14. headache
15. hematoma
16. hyperhidrosis
17. hypoesthesia
18. hypotension
19. hypoxia
20. injection site reaction
21. insomnia
22. leukocytosis
23. malaise
24. musculoskeletal pain
25. nausea
26. nightmares
27. orthostatic hypotension
28. paresthesias
29. pruritus
30. rash
31. skin irritation
32. splenic rupture
33. splenomegaly
34. syncope
35. thrombocytopenia
36. urticaria
37. vomiting
38. xerostomia

Monitoring Parameters

• CBC with differential
• platelet count
• serum creatinine
• weight

Contraindications

• breast-feeding
• contraception requirements
• hypotension
• leukemia
• leukocytosis
• pregnancy
• renal disease
• renal impairment
• reproductive risk
• shock
• thrombocytopenia

Interactions

There are no drug interactions associated with Plerixafor products.